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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607718
Report Date: 09/22/2021
Date Signed: 10/07/2021 02:06:16 PM

Document Has Been Signed on 10/07/2021 02:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 96CENSUS: 55DATE:
09/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Gwen CraigTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Pamela Bunker, conducted an unannounced POC visit. LPA Bunker met with Administrator Gwen Craig. LPA Bunker informed staff that the purpose of today's visit was to ensure that the “A" deficiencies cited on 08/14/19 during the complaint visit for Complaint Report dated 08/06/19, control number 11-AS-20190806162338 was corrected as required and is now in compliance according to Title 22 Regulations.

We observed the following deficiency:

87506 (c) (1) Resident Records:

The resident's files are no longer on the bookshelf in the receptionist/office area. The resident's binders with confidential information were removed to a safe locked room inaccessible to residents. Records are secured, safeguarded, and confidential.

The deficiencies initially cited have been corrected and cleared. Therefore, no civil penalties were assessed. LPA Bunker provided staff with a letter of Deficiency Citations Cleared.

There were no deficiencies cited. Exit interview conducted.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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